Prevalence of idiopathic normal pressure hydrocephalus in patients with vertebral compression fractures.

Background: Patients with idiopathic normal pressure hydrocephalus (iNPH) may be more prone to all fracture types due to falls. Vertebral compression fractures (VCFs) are a global burden that temporarily or permanently affects millions of elderly people. This study aimed to investigate the prevalence of iNPH in patients with VCFs. Methods: We retrospectively reviewed 128 patients aged 60-102 years who underwent balloon kyphoplasty (BKP) for VCFs between November 1, 2017, and March 31, 2020. We also assessed the presence of the iNPH triad (i.e., gait disturbance, cognitive impairment, and urinary incontinence). Patients with Evans' index (EI) >0.3 and the iNPH triad were defined as having possible iNPH, those with clinical improvement after a cerebrospinal fluid tap test were defined as having probable iNPH, and those with clinical improvement after a shunt surgery were defined as having definite iNPH. Results: Of the 128 patients, seven were excluded due to a history of intracranial disease that could cause ventricular enlargement or gait disturbance. Another 70 patients who did not undergo head computed tomography or magnetic resonance imaging one year before or after BKP were excluded from the study. Finally, 51 patients with a mean age of 78.9 years were enrolled. The mean EI value of these 51 patients was 0.28, with 18 patients showing EI >0.3. Moreover, 18 had possible iNPH, one had probable iNPH, and one had definite iNPH. Conclusion: Screening for iNPH in elderly patients with VCFs can allow early diagnosis of iNPH and benefit them more from surgical treatment.

Sideway Aspiration Technique for Thrombus in a Sharply Bifurcated Branch of a Large Vessel.

Objective: Standard thrombectomy techniques, including stent retrieval and a direct aspiration first pass technique, are not effective when the occluded vessel is narrow and sharply bifurcated from the main trunk. Here, we present a new and alternative method for patients with such anatomical features and describe two cases treated by this method. Case Presentations: Case 1 was a 66-year-old woman who presented with consciousness disturbance and left hemiparesis. MRA suggested a right middle cerebral artery occlusion. Case 2 was an 86-year-old man who presented with sudden onset of consciousness disturbance; MRA indicated occlusion of the basilar artery. Both cases were successfully treated by our new method. First, we navigated a microcatheter, microguidewire, and aspiration catheter into the patent and visible branch adjacent to the occluded branch. The aspiration catheter was then carefully pulled back with continuous mechanical aspiration. When reverse blood flow from the aspiration catheter was suspended, we slightly advanced the catheter and caught the thrombus. Complete recanalization was attained in the two cases treated with this technique, which was named as sideway aspiration technique (SAT). Conclusion: Although it warrants further study, SAT may be a potentially safe and effective method for thrombectomy in cases with thrombus in a sharply bifurcated branch.

[Lumbo-peritoneal Shunt Ventral Catheter Placement Using the Lateral Approach without Repositioning].

We reported 10 cases of lumbo-peritoneal(L-P)shunt placement using the lateral approach without repositioning. Each patient was placed in a left lateral position under general anesthesia and fixed so that the spine did not rotate. The skin incision on the flank was made at the height of the L4 vertebral body, 4 cm in the left-right direction and 3cm in front of the vertebral body. The external oblique, internal oblique, and transverse abdominal muscles were dissected to reach the peritoneum and confirm that the intestinal tract was peristaltic below the peritoneum. The peritoneum was lifted with hooked tweezers in order to separate them from the intestinal tract, and the peritoneum was incised with a scalpel to reach the peritoneal cavity. Using a finger and a shunt passer, the ventral catheter was guided between the muscle layers. Preoperative abdominal CT showed that all 10 kidneys in this case series were cephalic from the predicted approach route. The ascending colons of three patients were partially in contact with the predicted approach route. During surgery, a ventral catheter could be inserted in all 10 cases. Postoperative abdominal CT showed no intraperitoneal hemorrhage or invasion into the retroperitoneal cavity of the ventral catheter. During the follow-up period, no invasion into the abdominal wall or infection was observed. The average operation time was 52.2 minutes. In order to avoid invasion into the retroperitoneal cavity, a surgical incision was performed without complications by incising the outer side of the lower abdomen and approaching via the external oblique aponeurosis.

Aspiration Catheter Reach to Thrombus (ART) Sign in Combined Technique for Mechanical Thrombectomy: Impact for First-Pass Complete Reperfusion.

OBJECTIVE: The important factor for successful first-pass complete reperfusion (FPR) after combined techniques for mechanical thrombectomy (MT) is unclear. We consider that for successful FPR, the aspiration catheter (AC) should reach to and hold the thrombus before the device is pulled out. Therefore, we defined an ART (AC reached thrombus) sign characterized by the cessation of reverse blood flow in aspiration pump and deformation of stent retriever (SR) at the tip of AC. The purpose of this study was to identify the impact of the ART sign on the outcomes of the combined techniques. METHODS: A retrospective analysis was conducted between January 2015 and September 2018 on the data of consecutive patients who underwent MT for anterior circulation stroke using both SR and AC at the first-pass procedure. We divided the patients into 2 groups based on whether the first-pass procedure achieved the ART sign (ARTs group) or not (Non-ARTs group). The primary endpoint was FPR defined as modified thrombolysis in cerebral infarction (mTICI) score of 3. RESULTS: Sixty-six patients were included in our study (n = 38, ARTs group; n = 28, Non-ARTs group). There were no differences at mTICI 2b/3 (97.3% versus 89.2%, P = .30), but the FPR and mTICI3 were more common in the ARTs group (81.5% versus 14.2%, P < .001; and 89.4% versus 32.1%, P < .001, respectively). CONCLUSIONS: ART sign in combined technique was found to be an important factor for successful FPR.